is care coordination a cahps measure

11Adapted from McDonald KM, Sundaram V, Bravata DM, et al. 1. Agency for Healthcare Research and Quality. Accessed: 26 September 2010. Research Triangle Park (NC): RTI Press; 2022 Nov. Quigley DD, Elliott MN, Slaughter ME, Talamantes E, Hays RD. Measure Maps and Profiles (continued, 3). = 3 corresponding measure items There are 37 different measures that map to the Patient/Family perspective of the 7 domains identified as relevant to the intervention in this example. A filled square () indicates that the measure has 3 or more items corresponding to that particular domain or that it is a composite measure related to that domain. 290-02-0017). Measure #4c. Care Coordination Measure Instruments, The Definitions of Care Coordination Domains, Appendix III: Advisory Group Participants, U.S. Department of Health & Human Services, Establish accountability or negotiate responsibility, Monitor, follow up, and respond to change, Align resources with patient and population needs. Mechanisms. The Cronbachs alpha for composite scores ranged between 0.61 and 0.91 for the combined adult survey (core CG-CAHPS plus PCMH supplement). http://psnet.ahrq.gov/glossary.aspx. The data source is a function of who is asked or assessed. Joint Principles of the Patient-Centered Medical Home. Epub 2021 Sep 20. J Gen Intern Med. 1. Development of and field test results for the CAHPS PCMH Survey. 12Adapted from National Quality Forum. Link to community resources. 290-02-0017). This site needs JavaScript to work properly. In this updated version of the Atlas, measure profiles also include information about three additional measure characteristics: patient age groups, patient conditions, and settings. In general, the Clinician & Group survey has more care coordination questions, however these are designed for care coordination at the provider . Technical Review 9 (Prepared by Stanford-UCSF Evidence-Based Practice Center under contract No. Washington, DC: 2011. We evaluated a five-item measure of care coordination included in the 2012 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare survey (n = 326,194 respondents, 46% response rate). MeSH In short, care coordination is a means to help achieve care goals: it aims to meet patient needs and preferences and to facilitate delivery of high-quality, high-value care. From the care coordination domains listed in the top rows on the left-hand side of the tables, find the domain(s) you selected and highlight across the row. The ACO REACH Model is a redesigned and expanded version of the Global and Professional Direct Contracting (GPDC) Model. The Consumer Assessment of Healthcare Providers and Systems Home and Community-Based (HCBS CAHPS) Survey is the first cross-disability survey for adults receiving long-term services and supports from state Medicaid home and community-based services and supports (HCBS) programs. Measure #6 (CPCQ) has an open square in the box for Information Transfer from the Patient/Family perspective, indicating that the CPCQ has only 1 or 2 questions focusing on this domain and perspective. The care coordination measurement framework includes activities that have been hypothesized as important for carrying out care coordination and broad approaches that have been proposed as means of achieving coordinated care. Rockville, MD 20857 All instrument items are available online. Supplemental Items for the Child Surveys 1.1. https://www.ahrq.gov/ncepcr/care/coordination/atlas/chapter5.html. Existing measures of care coordination were mapped to these domains to help users identify measures that might be of interest in relation to their measurement objectives. 1. Development and Testing: The draft instrument was revised based on a literature review and feedback that was provided from extensive field tests with various health care organizations, cognitive interviews, and stakeholders.1 The final instrument is endorsed by the National Quality Forum as well as the Ambulatory Care Quality Alliance (AQA). Responses covered experiences in the last 12 months and were compiled into a nationally available database.1. An open square () indicates that the measure contains only 1 or 2 items that relate to a domain. 5600 Fishers Lane Communicate.9 Share knowledge among participants in a patient's care. Intervention mechanism: Facilitate transition from inpatient to outpatient setting Domain: Facilitate Transitions Across Settings. ), and Facilitate Transitions (Transitions between which participants? 5600 Fishers Lane For an explanation of how our Care Coordination Measurement Framework might be envisioned as a subset of broader models, go to the box below. 7McDonald KM, Sundaram V, Bravata DM, et al. Monitor for successes and failures in care and coordination. CAHPS Surveys and Tools. Gomez-Cano M, Lyratzopoulos G, Campbell JL, N Elliott M, A Abel G. Cancer Med. Care/Care Coordination Domain o In FY 2019 it is called the Person and Community Engagement Domain . Patient-Reported Care Coordination is Associated with Better Performance on Clinical Care Measures. A description of the type of instrument(s). *Indicates that the measure as a whole focuses on the health care home model. Content last reviewed June 2014. Getting Care Quickly. 2003 Dec;38(6 Pt 1):1509-27. doi: 10.1111/j.1475-6773.2003.00190.x. Keywords: Table 2. This document describes methods for calculating the quality performance benchmarks for Accountable Care Organizations (ACOs) that are participating in the Medicare Shared Savings Program (Shared Savings Program) and presents the benchmarks for the quality measures for the 2020 and 2021 quality performance years. Donabedian A. Who is the intervention primarily targeted towards? Akinyelure OP, Colvin CL, Sterling MR, Safford MM, Muntner P, Colantonio LD, Kern LM. Format/Data Source. Content last reviewed June 2014. Vol 7, Chapter 5. Copies of the measure instruments will be collected in Appendix IV: Care Coordination Measures, currently under development. Facilitation may be achieved through activities designed to ensure timely and complete transmission of information or accountability. February 7, 2018 2 . Launch the self-paced patient experience course The supplement contains 17 items; 12 were mapped. Document No. Accessibility Specify mechanisms of achieving care coordination. A brief description of a model, framework, or design if utilized in the development of the measure. Table 1 lists coordination activities that have been hypothesized or demonstrated to facilitate care coordination and broad approaches commonly used to improve the delivery of health care, including improving care coordination. A one-factor categorical confirmatory factor analytic model indicated that five items constituted a coherent scale. American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, et al. Measures were mapped to a category if it matched a stated intent or purpose of the measure or a published use of the measure. Step 3. About the CAHPS Patient-Centered Medical Home (PCMH) Item Set. Table 2 shows some examples related to care coordination. An important limitation is that it does not provide insight into how to match capacity with needs or how to assess fit (short of measuring the ultimate outcomes of interest). sharing sensitive information, make sure youre on a federal The following includes a review of CAHPS care coordination-related questions, and consumer feedback on how care providers can work together to improve patient experience. Purpose: To measure consumers' experiences with a specific primary care physician and practice. The core instrument contains 31 questions; 9 were mapped. Link to Outcomes or Health System Characteristics: The CAHPS survey questions and data have been used for evaluating patient experiences with care delivery.2 Measure scores related to communication and care coordination were shown to be higher (more favorable) for patients seen by physicians in large, integrated medical groups compared with other practice settings.3 Study populations enrolled in care management programs also showed trends toward higher ratings of patient experience with provider communication via the CAHPS.4. The numbers in this box correspond to related measures that may be of use in evaluating this intervention. These characteristics identify the group or groups of patients whose care the measure is intended to assess. Format/Data Source: Survey comprised of 31 core items with an additional 64 supplemental items specific to adult specialty care. Refine the care plan as needed to accommodate new information or circumstances and to address any failures. However it is defined, care coordination will always have goals, it will be achieved through some combination of mechanisms, and it will be experienced through effects. Example research questions include, but are not limited to, those that are listed below. Facility Surveys are also available, including: (1) CAHPS Hospital Survey, (2) CAHPS In-Center Hemodialysis Survey, and (3) CAHPS Nursing Home Surveys. Purpose. Link to Outcomes or Health System Characteristics. Go to the Master Measure Mapping Table for the Patient/Family perspective and look across the Care Management domain row. The Consumer Assessment of Healthcare Providers & Systems (CAHPS) is an annual survey to measure member perceptions of their health plan and the quality of the health care service they receive. Care Coordination Measurement Framework Diagram. Measurement equivalence of the Consumer Assessment of Healthcare Providers and Systems (CAHPS. 1. 4. Epub 2021 Dec 5. Step b. Organizational and market influences on physician performance and patient experience measures. Step a. Community resources are any service or program outside the health care system that may support a patient's health and wellness. * Measures from HEDIS and CAHPS used data from the 2020 Star Ratings (collected in 2019 and unaffected by the COVID-19 PHE). Care coordination necessarily involves multiple participants. Keep in mind that a single mechanism may correspond to multiple domains. SEER-CAHPS can be used to answer many research questions focused on the quality of care for cancer patients and survivors. Measure profiles follow each individual measure mapping table and contain more detailed information on the measure (go to Figure 6) for an explanation of what information is included). Patient Perceptions of Care (PPOC) maps to 6 of the 7 relevant domains.Measure #40. Agency for Healthcare Research and Quality. Thank you for your help and support. If applicable, specific information is noted regarding the number of individual items and the domains, categories, or subtopics covered. Communication may occur through a wide variety of channels, but for the purposes of measurement, we distinguish two key modes of communication: While in practice interpersonal communication and information transfer often occur together, for the purposes of measurement, interpersonal communication is distinguished from information transfer by a two-way exchange of knowledge through personal interactions, while information transfer is characterized by the transfer of datawhether orally, in writing, or electronicallyand does not necessarily involve direct interaction between sender and receiver. Internet Citation: Chapter 5. A summary of relevant information concerning the development of the measure, as well as reliability and validity testing. Med Care. (When detailing specific measures, we provide information on types of participant interactions for items related to the Communicate domain or its subdomains). 3. The effects noted in the Chapter 1 are the ultimate endpoints of interest (e.g., clinical outcomes, utilization-related outcomes, quality of life, etc.). Context. Care Coordination Measurement Framework. Development of and field test results for the CAHPS PCMH Survey. Health Serv Res 2009;44(3):880-901. Q9 Easy for respondent to get necessary care, tests, or treatment Q18 Respondent got appointment with specialists as soon as needed. Source(s). Primary Care Assessment Survey (PCAS) maps to 5 of the 7 relevant domains.Measure #16c. At the population level, this includes developing system-level approaches to meet the needs of particular patient populations. In: Shojania KG, McDonald KM, Wachter RM, and Owens DK, eds. The supplement contains 51 items; 21 were mapped. CAHPS Patient-Centered Medical Home Supplementary Survey Child Version 1.1, CAHPS Patient-Centered Medical Home Supplementary Survey Child Version 1.1. Rockville, MD: Agency for Healthcare Research and Quality, June 2007. This set of domains may change as knowledge about care coordination grows. COU is an important opioid use measure that assesses new episode of opioid use and is upstream of the two existing opioid measures in the HPR measure set. Development and Testing. All three measures evaluate communication between patients and health care professionals but provide different views on the effect or experience of that activity. Your Patients' Experience Matters More than Ever Starting this year, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and the Health Outcomes Survey (HOS) results contribute more to your Star quality rating. Accessed: Accessed: 2 May 2016 3. https://www.ahrq.gov/downloads/pub/evidence/pdf/caregap/caregap.pdf, Find Additional Providers and Facilities for Spectrum Health Lakeland Plan Members. weight column indicates the weight of the item (maximum value = 3) in the overall score calculation. CAHPS Measures of Patient Experience Each CAHPS survey produces several measures of patient experience. The Context of our frameworkwhich includes the clinical setting and characteristics of the patient populationinfluence the need for care coordination. Facilitate transitions. Coordination Measures in the Atlas. Participants. Purpose: To assess processes of care and patients experiences with care provided by patient-centered medical homes (PCMH). The date the measure was published or released. Each profile is preceded by an individualized measure mapping table that shows the care coordination domains and perspectives of the specific measure. Resources Back cover. Format/Data Source: Survey comprised of 30 core items with an additional 17 supplemental items specific to child primary care. Care Coordination Measurement Framework, Chapter 4, Emerging Trends in Care Coordination Measurement, Appendix III. This framework is intended to grow with the field. Importance of CAHPS. When selecting care coordination measures, it may be helpful to consider which participants are interacting in the activities of interest to be measured and from which perspectives you wish to measure those interactions. The VA uses the Consumer Assessment of Healthcare Providers and Systems (CAHPS) family of surveys to measure patient experiences. 2018 Aug;56(8):736-739. doi: 10.1097/MLR.0000000000000942. Logic Model/Conceptual Framework: The CAHPS PCMH supplementary survey is based on the principles of the patient-centered medical home.3. Available at:http://www.ahrq.gov/cahps/surveys-guidance/cg/index.html. Accessed: 2 May 2016. Care Coordination Measure Instruments, U.S. Department of Health & Human Services, Establish Accountability or Negotiate Responsibility, Patient report of satisfaction with coordination of care, Nurses reports of confusion or hassle (e.g., time spent coordinating referrals), Quality of care (safe, effective, efficient, timely, equitable, patient-centered) measured through analysis of medical chart data, electronic health record, or administrative data. This instrument consists of 11 items, of which 6 were mapped. 1. Practice-level reliability of individual PCMH supplement items ranged from 0.11 to 0.95. 1. Care coordination measurement must also consider the context: which patient population(s), which setting(s), what timeframe. Many of the Broad Approaches included in our framework are structures of care, such as establishment of a health care home, use of a health IT system to improve coordination, or designation of a case manager. Special Caution. The working definitions for each framework domain were developed by drawing on a variety of sources. Hays RD, Mallett JS, Haas A, Kahn KL, Martino SC, Gaillot S, Elliott MN. Identify the measures relevant to your intervention. This allows users to quickly assess the degree to which each measure focuses on a particular domain of care coordination, as well as the burden of data collection (i.e., number of items) related to the specific domain. Added the following measures: 2024 HPR Required HEDIS, CAHPS and HOS Measures 1 HEDIS/CAHPS Measures Required for HP AccreditationCommercial Note: The "Weight" column indicates the weight of the item (maximum value = 3) in the overall score calculation. J Am Geriatr Soc. The specific activities employed when implementing the broad approaches often vary, are not always well described, and have coordination-related components that are not necessarily clearly delineated. Many, but not all, care coordination measures include aspects of both interpersonal communication and information transfer and, as such, we expect that many measures will map to both subdomains. CAHPS surveys are an integral part of CMS' efforts to improve healthcare in the U.S. Perspective. Sponsored by the Agency for Healthcare Research and Quality (AHRQ) since 1995, CAHPS is a set of standard surveys that measure health care quality as experienced by patients.5,6 CAHPS surveys ask patients to report on the extent to which the behaviors of accountable Additional information about the survey is available online. The interaction also might be measured from a system representative(s) perspective by examining the percent of office visits where discussion of a plan of care was documented in the electronic medical record. For further discussion of types of transitions, go to Points of Transition in Chapter 2. The individualized measure mapping tables provide information on the number of items related to each domain. London, England: Hodder Arnold, a member of the Hodder Headline Group; 2003. These might include financial resources (e.g., Medicaid, food stamps), social services, educational resources, schools for pediatric patients, support groups, or support programs (e.g., Meals on Wheels). For example, a system-level approach to meeting the needs of patients with cancer (the population) might be to establish a multidisciplinary tumor board meeting to help coordinate cancer care among the many relevant specialties. This instrument consists of 18 items, of which 10 were mapped. Monitor, follow up, and respond to change. Decisions regarding the types of information to include were based on input from the advisory groups (go to Appendix III: Advisory Group Participants). The CAHPS Health Plan Survey generates two types of results for reporting purposes: Rating measures are based on items that use a scale of 0 to 10 to measure respondents' assessment of their health plan and the quality of care received over a specified period of time. All patients admitted for CHF will be invited to participate. Align resources with patient and population needs. Effects of collaborative drug therapy management on patients' perceptions of care and health related quality of life. Appendix IV will be updated regularly. Therefore, some conceptual domains were grouped that were separate in other works and some provided more granularity. Vol 7, Chapter 5. A Spanish language version is available online. The composite had a strong unique association with the CAHPS global rating of health care, controlling for the CAHPS core composite scores. Available at: http://www.ahrq.gov/cahps/. Princeton, NJ: Mathematica Policy Research, Inc.; May 2004. In short, care coordination is a means to help achieve care goals: it aims to meet patient needs and preferences and to facilitate delivery of high-quality, high-value care. Supplemental items focus on additional aspects of care, including: (1) after-hours care, (2) behavioral health, (3) screening items for children with chronic conditions, (4) doctor communication with child, (5) doctor communication, (6) doctor thoroughness, (7) health improvement, (8) Identification of site of visit, (9) prescription medications, (10) provider knowledge of specialist care, and (11) shared decisionmaking. Med Care 2012;50 Suppl:S2-10. Challenges Facing CAHPS Surveys and Opportunities for Modernization [Internet]. 10Adapted from: Coordinating care for Medicare beneficiaries: Early experiences of 15 demonstration programs, their patients, and providers: Report to Congress. Consumer Assessment of Healthcare Providers and Systems (CAHPS) Adult Specialty Care 1.0. The PCMH supplementary survey consists of supplementary items designed for use with the CAHPS Clinician & Group survey child version 1.1. Rockville, MD 20857 Agency for Health Research and Quality CAHPS Web site, CAHPS Bibliography. Content last reviewed June 2014. The ACO CAHPS scores specifically are part of the ACO-34 data set. Format/Data Source: An 18-item supplemental survey that can be added to the CAHPS Clinician & Group (CG-CAHPS) Version 2.0 survey. Recommendations and Best Practices A list of which measure items map to which domains. For more detailed information on measure mapping, please refer to Appendix I: Measure Mapping Strategy. However, the Atlas focuses on perspectives as they relate to whether specific activities or approaches were carried out, or what intermediate outcome these mechanisms produced, as gateways to potentially achieving the ultimate endpoint experiences desired by the different stakeholders. National Library of Medicine HEDIS MY 2023 & CAHPS MY 2023 (Reporting Year 2024) Bookshelf Closing the quality gap: A critical analysis of quality improvement strategies. Table 6. Effects. 2023 Mar;71(3):810-820. doi: 10.1111/jgs.18135. Coordination activities are actions that help achieve coordination, whether employed in an improvised or systematic way. Our care coordination measurement framework may be understood in relation to other commonly used conceptual models. 3. ), Establish Accountability or Negotiate Responsibility (Whose responsibility? Measures were indexed, or "mapped," according to the care coordination domains included in the care coordination measurement framework (go to Figure 2), in order to indicate which aspects of care coordination a particular instrument measures. The survey includes the core questions contained in the CAHPS Clinician & Group Survey (Version 3.0), plus additional questions to measure access to and use of specialist care, experience with care coordination, patient involvement in decision-making, experiences with a health care team, health promotion and patient education, patient . Effects of collaborative drug therapy management on patients' perceptions of care and health related quality of life. https://www.ahrq.gov/ncepcr/care/coordination/atlas/chapter3.html. Some CAHPS surveys are used in Value-Based Purchasing (Pay for Performance) initiatives. Dr. Smith designed a program to improve post-discharge health outcomes for patients with congestive heart failure and to reduce readmissions related to CHF. When possible, feedback from measure developers was incorporated prior to finalizing the categorization for each measure. In particular, we find the Donabedian and Organizational Design models to be valuable, somewhat contrasting, lenses through which to view the flexibility of our framework. Perspective: Patients/Family Specify population: CHF patients. CAHPS was developed by the Agency for Healthcare Research and Quality (AHRQ) and is considered the industry standard for measuring patient experiences. Those effects will likely be perceived differently from three key perspectives: that of patients and family, of health care professionals, and of system representatives. . Step d. Identify relevant care coordination measures. Step c. Consider perspective(s) of interest. It provides an overview of the current care coordination measurement field, highlighting areas with many available measures and those with few measures. A version of the PCMH Supplement Survey is also available for adults. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey includes a wide range of questions, some of which are tied to care coordination. Agency for Healthcare Research and Quality, Rockville, MD. Ideally, the care plan anticipates routine needs and tracks current progress toward patient goals. It contains 11 of the 18 items included in the adult version and is intended for inclusion in the CAHPS Clinician and Group Child Version 1.1 Survey. The Michigan Department of Health and Human Services (MDHHS) assesses the perceptions and experiences of members enrolled in the MDHHS Integrated Care Organization (ICO) health plans as part of its process for evaluating the quality of health care services provided to eligible adult members in the ICO Program (also referred to as MI Health Link . Psychometric properties of the Consumer Assessment of Health Plans Study (CAHPS) 2.0 adult core survey. The core instrument contains 31 items; 9 were mapped. Organizational and market influences on physician performance and patient experience measures. Available at:http://www.ahrq.gov/cahps/. All questions were answered on a 4-point frequency scale. and transmitted securely. The https:// ensures that you are connecting to the Bethesda, MD 20894, Web Policies Please enable it to take advantage of the complete set of features! Assess needs and goals.10 Determine the patient's needs for care and for coordination, including physical, emotional, and psychological health; functional status; current health and health history; self-management knowledge and behaviors; current treatment recommendations, including prescribed medications; and need for support services. Scholle SH, Vuong O, Ding L, et al. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey is an optional quality measure that groups and virtual groups participating in MIPS can elect to administer. Consumers can best assess patients' experience with healthcare providers and staff in doctors' offices. Patients complete the survey, which addresses six domains: (1) access to care, (2) comprehensiveness, (3) self-management support, (4) shared decisionmaking, (5) coordination of care and (6) information about care and appointments.1 Six composites may be calculated using data from the combined CG-CAHPS with PCMH supplement.2, Development and Testing: The CAHPS PCMH supplement was tested in 3,129 parents of pediatric patients from 33 child practices in the Boston area. Internet Citation: Chapter 6. Coordination of care requires proactively identifying the patient's needs, organizing care and communicating vital information at the right time to the right people. The 2007 AHRQ Evidence Report on care coordination identified more than 40 definitions of coordination pertaining to a diverse set of patient populations, health care scenarios, and organizational situations.8 Descriptions of care coordination activities and interventions are also often ambiguous. Res Soc Adm Pharm 2006;2:129-42. For details of this mapping process, go to Chapter 5Measure Mapping. These summaries also provide information on validity and testing, links to care coordination outcomes, application settings and populations, and format and data source. HEDIS/CAHPS/HOS Measures Required for Health Plan AccreditationMedicare HEDIS MY 2023 (Reporting Year 2024); CAHPS MY 2022 (Reporting Year 2023); HOS MY 2022 (Reporting Year 2023) Sterling MR, Lau J, Rajan M, Safford MM, Akinyelure OP, Kern LM. Thus, as currently presented, this framework provides a starting place for understanding care coordination and, in particular, for indexing measures of care coordination. 3. Intervention mechanism: Faxing complete medical record from hospital stay, including test results, to primary care provider within 48 hours of discharge Domain: Information Transfer; Monitor, Follow Up, and Respond to Change. Please share this information with the other care providers and office staff at your practice. Clipboard, Search History, and several other advanced features are temporarily unavailable. But it may also be useful to assess it from a Health Care Professional(s), or System Representative(s) perspective, depending on the goals of the intervention. In: Shojania KG, McDonald KM, Wachter RM, and Owens DK, eds. Intervention mechanism: Through red-flag discussion, help educate patient about how they can best react to changing symptoms Domain: Interpersonal Communication; Support Self-Management Goals.
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